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In a growing number of transplant centers worldwide, altruistic donors are accepted to anonymously donate a kidney to a stranger. An important hesitation to expand these transplantation programs is the fear of evoking psychological distress in the altruistic donor after donation. To what extent this fear is justified has not yet been systematically investigated. In this study, 24 altruistic donors were interviewed on average 2 years after donation. Lifetime mental health history, current psychological complaints, satisfaction with and impact of the donation on well-being, motives for donation, communication with recipient and donation experience were assessed. Altruistic donors report a considerable positive impact of donation on psychological well-being, whereas negative impact was limited. Satisfaction with donation was very high. Although a history of a psychiatric diagnosis was ascertained in almost half of the donors, psychological complaints before and after donation were comparable to national average norm scores. Motives for donation were genuine and the experience of donation generally conformed to their expectations. In conclusion, living kidney donation to a stranger does not appear to exacerbate psychological complaints. Moreover, altruistic donors report considerable satisfaction and personal benefit. The exceptional gift of altruistic donors can contribute toward solving the current organ shortage issue.

Background: Policies with respect to altruistic living kidney donation to strangers (both nondirected and directed donation) should, in addition to medical criteria, preferably be based on valid attitude research data. However, deciding on what data are relevant is a normative issue. The challenge for both research and policy making is to bring together empirical and normative issues., Methods: By comparing two recent surveys, the authors shed light on the complex methodologic and ethical questions surrounding altruistic living kidney donation., Results: The authors found that the main methodologic issues were the distinction between the willingness to donate and the acceptability of the offer, the difference between public attitudes observed in surveys ("facts") and well-considered moral judgments ("norms"), and biases caused by a misperception of central moral concepts (e.g., discrimination and injustice). The authors argue that transplantation centers have a good case for applying or initiating altruistic living donation programs. Centers should seek to influence public attitudes if these attitudes are shown to be biased by prejudice and misunderstanding., Conclusions: The authors advocate an interaction between research and policy making. Social research can best influence transplantation policies in altruistic living donation by in-depth interviews into the complicated background beliefs underlying personal preferences. In addition, the public should be encouraged to judge the immanent issues in a morally responsible way. In the end, a fair balance should be established between the impartial requirements of social justice and the partial motivations of individuals involved in altruistic living donation. Although discriminatory acts should be rejected categorically, donation policies should be willing to consider, support, and accept motivations based on personal loyalties.